Adem, diagnostic dilemma, a tertiary care hospital experience:

Acute disseminated encephalomyelitis (ADEM) is an uncommon inflammatory demyelinating disease of the central nervous system that usually occurs following a viral infection or vaccination, bacterial or parasitic infection, or even spontaneously. ADEM is a monophasic; poly symptomatic disorder but it may present with various combinations of motor, sensory, visual and cognitive symptoms. Some case reports of ADEM presented as psychiatric disorders primarily as confusion psychosis and at times dissociative disorder. At times, the diagnosis becomes a dilemma due to multifaceted picture. Due to confusion physician may go to extreme range of tests with no specific conclusion. Debates regarding exact diagnosis have always been there. Reports regarding ADEM are lacking from our country. The aim of our study is to look for the presenting features of the disease and the path to final diagnosis

20th annual meeting of pakistan society of neurology bhurban, islamabad april 2013

: Stroke is a major preventable public health challenge. Diabetic patients constitute a fair percentage of patients with stroke. Numerous epidemiological studies in the United States and Europe suggest that one fifth of stroke patients have diabetes.We evaluate the risk factors leading to stroke in Diabetic patient

Pharygeal Cervicobrachial Variant Of Guillian -barre Syndrome

Guilain-Barre Syndrome (GBS) is a common cause of Neuro-muscular paralysis with a spectrum of clinical and electrophysiology variants. We present a case of thePharyneo-cervico-brachial type. A 25 yr old male came to the Medical OPD with the complains of one day history of upper limb weakness and decreased flexion of the neck , which was progressively worsening, along-with associated shortness of breath. His systemic inquiry and past medical/surgical histories were insignificant. Physical exam correlated withthe diagnostic criteria of PCB variant of GBS. Diagnosis was confirmed on EMG/NCS,which showed axonal neuropathy involving axillay and musculocutaneousnerve, along with absent F –waves latencies inleft median nerve. He showed significant improvement in his weakness over a course of 12 days. Such a case has not been reported to the best of our knowledgefrom our part of world, as of yet

Early electrophysiological findings in guillain barre syndrome

Early electrophysiological testing is more important as early abnormalities can be obtained even in the first week. However the electrical abnormalities may not be that prominently evident for definitive diagnosis in the first 2 weeks. However at times the decision of treatment has to be taken early. Research is required to look at different electrophysiological parameter which could give clue for an earlier diagnosis. The aim of our study is to determine early electrophysiological parameters with in first week to identify GBS at earliest

Cerebral cavernous malformation presenting as seizures

Cerebral cavernous malformations (CCMs) is one of the rare vascular malformation. It is diagnosed by characteristic lesions on magnetic resonance imaging (MRI). CCMs typically appears as a “popcorn-like” masses on T2-weighted images on MRI studies.And clinically can lead to headaches, seizures,focal neurological deficits or intracerebral hemorrhages. . A familial form is suggested if lesions are multiple, and a sporadic form, if singl

delay in diagnosis of motor neuron disease. a tertiary care experience

Motor Neuron Disease is a progressive neurological disorder with poor prognosis. Inability to correctly recognize the disease, leads to undue agony and diagnostic dilemma. Studies have been done to look at the average duration taken to diagnose the disease from the onset of symptoms. The literature shows that latency from symptom onset to diagnosis range from 10.6–17.5 months. No such study has been conducted in our region. We reviewed 62 patients referred to the neurophysiology lab from year 2009 to 2013 with quarry of MND. Only 40 patients were identified to fulfill the El Escorial criteria for MND. The median time of diagnosis from onset of symptoms was one year. This is almost similar to that of world literature. We conclude that in spite of paucity of heath service and high rate of illiteracy the timeliness of diagnosis was consistent with the rest of the world

Correlation of duration of diabetes with upper limb musculoskeletal problems

Long standing uncontrolled diabetes is associated with many clinical problems and it frequently involves hands and shoulder causing stenosing tenosynovitis (trigger finger), Dupuytren\u27s contracture, carpal tunnel syndrome, limited joint mobility and shoulder capsulitis. The prevalence of hand symptoms has been variable in different studies. Data from our part of world is scares. Our study aimed at looking at frequency of these hand symptoms with duration of the diabetes

WHAT DIABETICS KNOW ABOUT DIABETES?

Patient’s lack of understanding of disease hinders in proper control of disease thus increasing the morbidity and mortality. Review of the studies done in this region, dose not provide a detail account of patients understanding about the disease. Majority of patients when interviewed in clinics do not know the right answer to cause, level of desired sugar, possible complication. Material and methods: Hospital-based cross-sectional KAP study was conducted on diabetic patients visiting the diabetic clinic in two tertiary care Hospitals and a diabetic poly clinic in different areas of Karachi during the month of September 2012. Results: The mean age was 56 years, with 122 male and 118 female, 40.4 % patients were uneducated, 22.9% metric, 12.9% intermediate and 22.9% were graduate. Considering the knowledge, as to what is diabetes? only 46% answered correctly. What could cause the disease? 35% thought there was no reason for sugar. Regarding most frequent symptom, 27% thought there were no specific symptoms, 24.2% weight loss and 23.8% excessive urine and 21.7% thought not healing of wound was first indicator and 2.1 % thought that increase appetite is the cause. The desired levels of random sugar only 24.2% thought it be around 180 mg /dl while 32.5% had no idea about the value. Desired fasting sugar was correctly known by 34.6% as less than 100 mg/dl and 22.9% as less than 120 mg/dl. , Duration of treatment was believed to be life long treatment by 85%.Oral hypoglycemic were consumed by 68%, 24% were on insulin. And 6% were using both. 75% patients did not do exercise regularly. Regarding the harms created by diabetes, 51.3 % knew that heart or kidneys may get damaged. Regular doctor visits were done by 80% , and 85 % were satisfied with the level of care. The average sugar check cost was less than 100 rupees for 62.1 % . Conclusion: Lack of proper concepts regarding the disease, desired level of sugars, possible complications could be a big hinder in achieving good diabetic control. Thus by addressing the specific deficiencies in the knowledge and practices of patients, a better outcome may be achievable